Postprocedural management of adults with type 1 diabetes

Postprocedural management of a patient with type 1 diabetes depends on how soon after the procedure they can eat normally.

After a short procedure or day surgery, patients should not be discharged home until they are able to tolerate food and oral fluids. They must be well enough to self-manage their insulin injections or CSII pump, have immediate access to a fast-acting glucose source (see Examples of products containing approximately 15 g of glucose), and have an emergency number to ring for advice about their glycaemic management over the next 24 to 48 hours.

If the patient continues to fast after a procedure or is not eating normally (eg due to sedation, nausea, vomiting, oral pain), blood glucose concentrations must be measured hourly, and basal insulin (either by subcutaneous injection or basal rate insulin by CSII pump) must be continued. If the patient has not resumed eating normally after the procedure, the insulin dose and regimen need review.

Unstable patients who are not eating should be managed with an intravenous insulin infusion.

Patients with type 1 diabetes should not drive themselves home after a procedure because they have an increased risk of hypoglycaemia.